Skip to main content


         This documentation site is for previous versions. Visit our new documentation site for current releases.      
 

Uploading code sets to Pega Foundation for Healthcare

Updated on January 10, 2022

Upload the code sets to Pega Foundation for Healthcare that you need to meet your organization's needs. A code set includes codes that are used for encoding data elements, such as tables of terms, medical concepts, medical diagnosis codes, or medical procedure codes.

Pega Care Management Implementation Guide Pega Care Management Implementation Guide Pega Care Management Implementation Guide
For example, the industry-standard ICD-10 code sets consist of two parts.
  • ICD-10-CM diagnosis coding that is used in all United States healthcare environments
  • ICD-10-PCS inpatient procedure coding that is used in United States hospital environments

Follow the steps that describe how to upload code files in the Pega Foundation for Healthcare Common Codes Solution Business Use Case Guide on the Pega Documentation home page.

Modifying code groups for a medical necessity review

Your care management application includes two code groups that you can modify to make a medical necessity review that meets your business needs. Use the Diagnosis codes for mandatory medical necessity review and Procedure codes for mandatory medical necessity review code groups.

Before you begin: Ensure that you have an open ruleset. For more information, see the Pega Foundation for Healthcare Business Use Case Guide on the Pega Documentation home page.
  1. Log in to the Code Manager Portal of your application by entering the CodeManager@PegaHealthCodes operator ID and the password that you specified.
  2. In the Code Manager Portal header, click SearchCode Group.
  3. In the Search for field, enter Diagnosis codes for mandatory medical necessity review and click Search.
  4. In the results list, select and open the specified code group.
    For information, see the Pega Foundation for Healthcare Common Code Solution Business Use Case Guide on the Pega Documentation home page.
  5. In the portal header, click SearchCode Group.
  6. In the Search for field, enter Procedure codes for mandatory medical necessity review and click Search.
  7. Repeat step 4.

Configuring sample code group modifications

By using the Healthcare Common Codes solution that is provided by Pega Foundation for Healthcare, you can modify sample code groups or establish new code groups to fit your business needs. Use the Diagnosis codes for mandatory medical necessity review and Procedure codes for mandatory medical necessity review code groups.

  1. Log in to the Code Manager portal of your application by using the credentials that you specified for Pega Foundation for Healthcare.
    For more information, see the documentation on the Pega Documentation home page.
  2. In the Code Manager Portal header, click Code Groups.
  3. In the Search field on the Code groups page, enter Diagnosis codes for mandatory medical necessity review and click Search.
  4. In the results list, select and open the specified code group, and discuss the codes that you want to add.
  5. In the Search for field, enter Procedure codes for mandatory medical necessity review and click Search.
  6. Repeat step 4.
  • Previous topic Definition of Pega Care Management application components
  • Next topic Creating goal templates in Pega Care Management

Tags

Pega Care Management 8.7

Have a question? Get answers now.

Visit the Support Center to ask questions, engage in discussions, share ideas, and help others.

Visit the Support Center

Did you find this content helpful?

Yes
No

Want to help us improve this content?
Suggest an edit

We'd prefer it if you saw us at our best.

Pega.com is not optimized for Internet Explorer. For the optimal experience, please use:

Close Deprecation Notice
Contact us